Elefantiasis: Thickening and hardening of skin

Elefantiasis is a chronic skin disease occurring in the tropics, caused by a threadworm. The larvae of this worm are transmitted to humans through repeated bites from an infected female blood-sucking mosquito. With the disease, the patient develops attacks of lymphatic vessel inflammation in combination with lymphatic congestion. The blockage of the lymphatic system causes hardening and thickening of the skin of the limbs and external genitalia. This disfiguring infectious disease can be treated with medication and surgery.

  • Synonyms elephantiasis
  • Epidemiology parasitic infectious disease
  • Causes: Threadworm causes blockage of the lymphatic system
  • Symptoms: Thickening and hardening of skin
  • Diagnosis and examinations
  • Treatment with medication and surgery
  • Prevention through medicines

Synonyms elephantiasis

Elephantiasis is also known under these synonyms:

  • elephantiasis
  • elephantiasis arabum
  • lymphatic filariasis
  • elephant leg
  • elephantiasis

Epidemiology parasitic infectious disease

The condition affects more than 120 million people worldwide, of which 40 million are affected by a severe form of the disease. Elephantiasis is most common in the population of India. People from Africa are also often affected. The disease also occurs in South Asia and America. The infection is best known in tropical and subtropical areas. Men and women are equally affected and patients are of all ages.

Causes: Threadworm causes blockage of the lymphatic system

A female blood-sucking mosquito bites a human and thus transmits pinworm larvae (microfilariae) to humans (spreading). The parasite grows into an adult worm and lives in the human lymphatic system.

There are three types of these thread-like filaria worms:

  • Wuchereria bancrofti is responsible for 90% of cases
  • Brugia malayi causes the disease in most other individuals
  • Brugia timori also has the ability to bring about the disease

Elefantiasis is the result of an obstruction of the lymphatic system, causing lymphatic fluid to accumulate in the affected areas. The lymphatic system is part of the immune system. The lymphatic system helps the body fight infections and diseases. This consists of a network of tubular channels (lymphatic vessels) that drain lymph fluid from various body areas into the bloodstream. An obstruction of these lymphatic vessels results in massive swelling and enlargement of limbs and the external genitalia.

Symptoms: Thickening and hardening of skin

Elephantiasis is usually asymptomatic, meaning the patient has no outward signs of the infection. However, these asymptomatic infections still affect the lymphatic system, making changes to the body’s immune system. An infected mosquito usually bites children, who then have hidden lymphatic damage. The symptoms of the disease only become apparent later in life, and the symptoms often only appear with repeated exposure to mosquito bites over many years. The disease causes recurring attacks of lymphangitis (inflammation of lymphatic vessels), usually caused by bacteria, accompanied by fever and headache. In combination with the resulting lymphatic congestion, this leads to enormous thickening and hardening of the skin (pachyderma) of the legs and/or arms and/or the external genital organs. This not only causes pain and severe limitation in range of motion, but also results in social stigma.

Diagnosis and examinations

The standard test for detecting the infection consists of a microscopic examination of a blood smear. The pathologist examines whether the microfilariae of the parasite are present. This blood test is best done at night because the microfilariae then circulate in the blood.

Treatment with medication and surgery

The main drug for treating this condition is diethylcarbamazine or DEC. This drug is an anthelmintic (worm killing drug). Most patients have no problems taking this medicine, but possible side effects include dizziness, fever, and sore muscles (myalgia). In many cases, medical treatment alone is not sufficient and surgery is necessary. When the male genitalia are affected, reconstructive surgery on the penis and scrotum is often successful. Lymphatic tissue can also be removed via surgery or radiotherapy. Other treatments are intended to be symptomatic and supportive.

Prevention through medicines

Lymphatic filariasis can be prevented to stop the spread of the infection. This is done through preventive medication with a single dose of two drugs for persons living in areas where the infection is present.